Lung-cancer screenings advised until age 80

Friday

Jan 3, 2014 at 12:01 AMJan 3, 2014 at 11:24 AM

Local hospitals are likely to make low-dose CT lung screenings available to an older population of smokers and ex-smokers because of a recommendation this week by the influential U.S. Preventive Services Task Force.

Ben Sutherly, The Columbus Dispatch

Local hospitals are likely to make low-dose CT lung screenings available to an older population of smokers and ex-smokers because of a recommendation this week by the influential U.S. Preventive Services Task Force.

The guidance was published in the Annals of Internal Medicine.

Screenings can make a significant difference for patients when they catch cancer early. The average five-year survival rate for lung cancer is just

17 percent, but it is 52 percent when the disease is diagnosed at an early stage. However, only

15 percent of lung-cancer cases are diagnosed that early, the task force said.

The task force recommends annual scans for people who are 55 through 80 years old and have smoked the equivalent of one pack of cigarettes a day for 30 years.

In keeping with the findings of other research, Mount Carmel Health System and OhioHealth have been screening smokers who are 55 through 74 years old. Ohio State University’s screening program has been available to smokers ages 55 through 79. For all three programs, people must have smoked the equivalent of one pack a day for 30 years. Eligible former smokers must have quit within 15 years.

As a result of the task force’s recommendation, doctors associated with the screening programs at Mount Carmel, OhioHealth and Ohio State said they probably will increase the maximum eligibility age to 80.

The recommendation is “the one we’ve been waiting for,” said Dr. Patrick Nana-Sinkam, a pulmonologist who oversees the screening program at OSU’s Arthur G. James Cancer Hospital. “This is the organization that really has the final say for screening and preventive strategies across many diseases.”

“This will dramatically increase the number of people we’re able to screen,” said Dr. Brian Hamburg, a pulmonologist who participates in Mount Carmel’s lung-cancer screening program.

The National Lung Screening Trial, which has provided the best evidence of the benefit of screening, screened its participants annually for three years. But many doctors and clinicians have been unsure how long they should screen patients beyond three years. The task force provided guidelines on that point, stating that patients should continue to receive annual screening until:

• They “age out” of the high-risk age group.

• Fifteen years have passed since they quit smoking.

• They develop a health problem that substantially limits their life expectancy.

Screenings also aren’t recommended if:

• The patient is not willing to take action — that is, undergo surgery — if a screening leads to a diagnosis of cancer.

• The patient has other substantial medical conditions, particularly if that person is at the upper end of the screening age range.

Such screenings are not without risks, the task force noted, citing the strong probability of false-positive results; 95 percent of all positive results do not lead to a diagnosis of cancer. Such findings can lead to “a cascade of testing and treatment that might mean more harm, including the anxiety of living with a lesion that may be cancer,” the task force noted.

And then there is the problem of overdiagnosis, said Dr. Virginia Moyer, the task force’s chairwoman. In some cases, people are treated for cancer that, left alone, would not have caused harm. Doctors are not yet able to distinguish between such cancers and the harmful types, Moyer said. “Major surgery is not something to do lightly.”

About 160,000 people in the United States die from lung cancer each year, and screenings might prevent about 20,000 of those deaths, Moyer said.

Screening is imperfect, but “we wouldn’t be in this mess if we didn’t have people smoking,” she said.

Screening is not a substitute for quitting, Moyer said, and smoking cessation should be offered to smokers in conjunction with CT scans.